【摘要翻译】 胸腺基质淋巴生成素( TSLP) 触发树突状细胞介导的Th2 型炎症反应。一个位于TSLP 基因启动子区域的rs3806933 位点的单核苷酸多态性能产生转录因子激活蛋白( AP) -1 的结合位点。这种变异增强了AP-1 结合到调控元件的能力, 并增强聚肌苷酸胞苷酸刺激人类正常支气管上皮细胞时TSLP 启动子-报告子反应活性。我们研究了这种包括rs3806933 位点的多态性是否影响支气管哮喘的易感性和临床表型。我们选择了三个具有代表性的单核苷酸多态位点进行TSLP 基因相关性研究, 对象为两个独立的人群( 其中一个为693 例儿童特应性哮喘患者和838 例对照者, 另一个为641 例成年哮喘患者和376 名对照者) 。我们进一步检测了糖皮质激素和长效β2 受体激动剂( 沙美特罗) 对聚肌苷酸胞苷酸刺激的人类正常支气管上皮细胞TSLP 基因表达的影响。我们发现启动子多态性位点rs3806933、rs2289276 与儿童特应性哮喘和成人哮喘的易感性均显著相关。功能单核苷酸多态性位点rs3806933 与哮喘相关( Meta 分析, P = 0. 000056; 比值比, 1. 29; 95% 可信区间, 1. 14 ～1. 47) 。Rs2289278 的基因型和肺功能相关。并且, 糖皮质激素和沙美特罗可协同性地抑制聚肌苷酸胞苷酸刺激导致人类正常支气管上皮细胞TSLP mRNA 及蛋白的上调表达。TSLP 多态性变异与支气管哮喘和肺功能显著相关。因此, TSLP可能作为联合治疗的分子靶点。【述评】 越来越多的研究表明哮喘是一种环境和遗传因素相互作用的疾病。本研究不但发现TSLP 启动子多态rs3806933、rs2289276 与儿童特应性哮喘和成人哮喘的易感性均显著相关, 并研究了其导致哮喘炎症反应可能与该多态性位点产生激活蛋白( AP) -1 的转录因子的结合位点。这种变异增强了AP-1 结合到调控元件从而导致基因表达异常。同时, 作者还发现临床常用的哮喘治疗药物ICS 与LABA 的联合制剂可调节TSLP 表达。这些数据表明TSLP在哮喘发病中起重要作用, 并进一步阐明ICS 与LABA 联合治疗的分子机制。该研究不但从分子遗传和分子生物学的角度阐明TSLP多态性在哮喘发病中的分子机制, 并从分子药理层面进一步证实目前常用哮喘治疗方案的合理性, 研究较为深入。
ObjectiveTo investigate the efficacy of Orem's self-care model in school-age children with asthma. MethodsSeventy-four children with asthma treated between March 2012 and June 2014 were divided into observation group (n=37) and control group (n=37) randomly. Orem's self-care model was applied in the observation group, while routine nursing was carried out in the control group. We observed the pulmonary function, therapeutic compliance and quality of life in children of both the two groups before and one year after treatment. ResultsOne year after treatment, forced expiratory volume in one second and peak expiratory flow increased significantly (P<0.05), and increase in the observation group was significantly more than that in the control group (P<0.05). Compared with the control group, the observation group showed significant increased treatment compliance rate (P<0.05). Pediatric asthma quality of life questionare scale results showed that one year after treatment, the two groups got significantly increased scores in the dimensions of emotion, symptom and activity (P<0.05), and the scores were significantly higher in the observation group (P<0.05). ConclusionOrem's self-care model has a significant curative effect for the improvement of lung function in school-age children with asthma, which can promot the treatment compliance and quality of life of the patients.
Objective To explore the relationship between nasopharyngeal microecology and diseases in children with bronchial asthma. Methods A total of 41 children with asthma who were treated in Hainan Provincial Hospital of Traditional Chinese Medicine between November 2020 and March 2023 were retrospectively included in the study, and 26 healthy children undergoing adenoid examination in the same period were selected as the control group. Samples of nasal mucosa were collected from the anterior and medial side of inferior turbinate, and the expression of DEFB2, IL17A, TSLP, IL13, IL5 and T1R3 genes was analyzed by polymerase chain reaction. Nasal swabs were collected from the children, and the bacterial composition was analyzed by 16S ribosomal RNA gene sequencing. Results Compared with the control group, the rate of atopy cases in the asthma group increased significantly (53.7% vs. 19.2%, P<0.05). At the phylum level, compared with the control group, the phylum Chloroflexi, the phylum Patescibacteria, the phylum Tenericutes and the phylum Nitrospirae in the asthma group increased significantly (P<0.05), and the phylum Elusimicrobia decreased significantly (P<0.05). At the genus level, compared with the control group, the members of Bacillus (Fimnicutes), Ruminococcus (Fimnicutes), Rhodococcus (Actinobacteria), Acinetobacter (Proteobacteria), Moraxella (Proteobacteria) and Asaia (Proteobacteria) in the asthma group increased significantly (P<0.05), and the members of Enterococcus (Fimnicutes), Alkanindiges (Proteobacteria), Rickettsia (Proteobacteria), and Rhizobium (Proteobacteria) in the asthma group decreased significantly (P<0.05). Compared with the control group, the Shannon index of the asthma group decreased significantly (2.63±1.45 vs. 3.90±1.44; t=2.708, P=0.010). According to receiver operating characteristic curve analysis, the optimal cut-off point of Shannon index was 3.10. In all study populations, compared with children whose Shannon index was higher than the cut-off point, children whose Shannon index was lower than the cut-off point were characterized by increased expression of IL17A and T1R3 (P<0.05) and decreased expression of TSLP (P<0.05). Conclusion The composition and abundance of nasopharyngeal microbiota are significantly different between children with asthma and healthy control children.
Objective To investigate the value of procalcitonin-guided treatment on antibiotic use in severe acute exacerbations of asthma. Methods From April 2008 to December 2010, a total of 77 patients with severe acute exacerbations of asthma were randomly assigned into a PCT group ( n =38) and a control group ( n=39) . The serum concentration of procalcitonin ( PCT) were measured in all patients. On the base of similar routine treatment, the control group received antibiotics based on the physician’s decision.Meanwhile the PCT group were treated with antibiotics according to serum PCT levels: antibiotic treatment was applied with PCT level ≥0. 25ng/mL and was discontinoued with PCT level lt; 0. 25ng/mL. Length of hospitalization, duration of antibiotics, cost of antibiotics, clinical efficacy were observed. Results The duration of antibiotics use in the PCT group [ 7 ( 5 ～11) d] was shorter than that in the control group [ 11( 7 ～16) d] ( Z = - 2. 26, P = 0. 025) , and the cost of antibiotics in the PCT group [ 2125( 1560 ～4347) yuan] was lower than that in the control group [ 3588 ( 2677 ～5280) yuan] ( Z = - 2. 01, P =0. 033) . The clinical efficacy and length of hospitalization were similar in two groups ( P gt; 0. 05) .Conclusion PCT guidance can reduce antibiotic duration and antibiotic cost in treatment of acute severe exacerbations of asthma.
Objective To investigate the changes of small airway function and diffusing capacity in patients with mild asthma before and after bronchial provocation test (BPT).Methods BPT was performed in suspected asthma patients with chief complaints of paroxysmal wheeze,chest tightness and cough，but with normal chest X-ray and baseline pulmonary function.BPT positive group was regarded as asthma group，while BPT negative group as control group.Lung volume，ventilatory function and diffusing capacity were measured before and after BPT and compared between the asthma and control groups.Results （A）No statistical differences were found in FEV1%，FEV1/FVC，FVC%，VC%，TLC%，FRC%，RV%，RV/TLC between the asthma and control groups before BPT.FEV1/FVC and FVC% were significantly decreased (all Plt;0.01)，while FRC% (Plt;0.05)，RV% (Plt;0.01) and RV/TLC (Plt;0.01) increased significantly in the asthma group after BPT compared with the control group.The decline rate of FEV1/FVC and FVC% and the increase rate of TLC%，RV%，RV/TLC were significantly higher in the asthma group than those in the control group (all Plt;0.01).（B）Compared with the control group，FEF25%-75% (Plt;0.05)，Vmax75% (Plt;0.01) and Vmax50% (Plt;0.05) were significantly lowered before BPT，while the above parameters and Vmax25% were significantly decreased after BPT in the asthma group (all Plt;0.01).The decline rate of FEF25%-75%，Vmax75%，Vmax50% and Vmax25% was significantly higher in the asthma group than those in the control group (all Plt;0.01).（C）There was no statistical difference in DLCO in both groups before and after BPT.Conclusions Patients with mild asthma had small airways impairment before BCT which further declined after BPT.However,no impairment of diffusion capacity was found before or after BPT.
Objective To investigate and discuss the prevalence and the relevant risk factors of bronchial asthma in Shenzhen city China. Methods We used standard scheme and questionnaire, and performed stratified-cluster-disproportional-random-sampling survey for the population of five communities. Results A total of 6 248 people were surveyed. 50.5% (3 156 of 6 248) of whom were men and 49.5% (3 092 of 6 248) were women. In this survey, forty asthma patients were found, and the overall prevalence rate was 0.64%, three groups with higher prevalence were 66 to 75 years (54‰), 56 to 65 years (23‰) and 14 to 17 years (12‰) respectively. Risk factors found that among 40 asthma patients, people often exposed to secondhand smoking were reported by 40% and children exposed to their father’s smoking from fetus were reported by 57%. People with asthma with allergic rhinitis were reported by 50%. The attacks were caused by common cold and changing temperature or inhaling cold air were 45% and 30% respectively. About 86% of children suffered from asthma before 2 years old. Conclusion This survey has basically reflected the distribution, frequency and intensity of asthma. The overall prevalence rate is 0.64% from which it would be estimated that there could be 25 900 asthma patients in Shenzhen city, the relavent data will provide basis for the future research, mass prevention and the treatment of asthma.
小气道病变曾经是全球呼吸界研究的热点，许多肺功能测定方法和指标被用于小气道功能的诊断，其后热度骤减，最近又引起一些学者的重视。